1295033801 NPI number — CONVENIENT COUNSELING, LLC

Table of content: POLINA YUR'YEVNA SAYESS MD (NPI 1992902456)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295033801 NPI number — CONVENIENT COUNSELING, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CONVENIENT COUNSELING, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295033801
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/05/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13548 DISCOVERY DR
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
OMAHA
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68137-3003
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-659-4109
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13548 DISCOVERY DR
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
OMAHA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68137-3003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-659-4109
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/05/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
OSBORNE
Authorized Official First Name:
PAMELA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
402-659-4109

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  383, 1802, 880 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)